Assessment Form

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Friends of Non-Profits

Convenient Assessment Form

Contact information: (items with * are required)

Organization Name	Invalid Input
Address Line 1	Invalid Input
Address Line 2	Invalid Input
City	Invalid Input
State	Invalid Input
Zip Code	Invalid Input
Contact Name (*)	Invalid Input
Email address (*)	Invalid Input

Phone#	Invalid Input	For faster response, enter phone number as 213-555-1212
Cell Phone#	Invalid Input
FAX #	Invalid Input

Does your organization have Tax Exempt Status? (*)	YesNoPending Invalid Input
In what year was your organization established?	Invalid Input
If your organization has a website, please enter the web address here.	Invalid Input
Please give us a brief description of your Non-Profit / Charity.	Invalid Input
Please list your current sources of income, such as "Bake Sales", "Direct Donations", "Endowments", etc.	Invalid Input
Please describe the purpose of the funding you are seeking.	Invalid Input
How much grant funding are you seeking? (*)	$5,000 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 More than $500,000 Invalid Input

Please type the letters you see into the box before pressing the Submit button	Refresh Invalid Input	If you cannot read the letters, click link to Refresh the letters.
Thanks for filling out our questionnaire.